Intraosseous device and methods for accessing bone marrow in the sternum and other target areas

ABSTRACT

Apparatus and methods are provided to access bone marrow at various target areas. Such apparatus may include an intraosseous device operable to penetrate bone at a selected target area and a depth limiter operable to control depth of penetration of the intraosseous device into bone and associated bone marrow. A manual driver and a guide may be included to optimize optimum insertion of the intraosseous device at a selected insertion site on a sternum.

This application is a Continuation under 35 U.S.C. §120 of U.S. patentapplication Ser. No. 11/620,927, filed Jan. 8, 2007, which is aContinuation-in-part under 35 U.S.C. §120 of U.S. patent applicationSer. No. 10/987,051 filed Nov. 12, 2004, to which the presentapplication also claims priority. These applications are incorporated byreference in their entirety.

This application makes cross-reference to the following relatedapplications: U.S. patent application Ser. No. 10/449,503 filed May 30,2003; and U.S. patent application Ser. No. 11/023,173 filed Dec. 27,2004.

TECHNICAL FIELD

The present disclosure is related to apparatus and methods to accessingbone marrow at various target areas including, but not limited to, apatient's sternum.

BACKGROUND OF THE DISCLOSURE

Every year, millions of patients are treated for life-threateningemergencies in the United States. Such emergencies include shock,trauma, cardiac arrest, drug overdoses, diabetic ketoacidosis,arrhythmias, burns, and status epilepticus just to name a few. Accordingto the American Heart Association, more than 1,500,000 patients sufferfrom heart attacks (myocardial infarctions) every year, with over500,000 of them dying from its devastating complications. Many woundedsoldiers die within an hour of injury, usually from severe bleedingand/or shock. Many of these soldiers die unnecessarily becauseintravenous (IV) access cannot be achieved in a timely manner.

An essential element for treating many life threatening emergencies israpid establishment of an IV line in order to administer drugs andfluids directly into a patient's vascular system. Whether in anambulance by paramedics, in an emergency room by emergency specialistsor on a battlefield by an Army medic, the goal is the same—quickly startan IV in order to administer lifesaving drugs and fluids. To a largedegree, ability to successfully treat most critical emergencies isdependent on the skill and luck of an operator in accomplishing vascularaccess. While relatively easy to start an IV on some patients, doctors,nurses and paramedics often experience great difficulty establishing IVaccess in approximately twenty percent of patients. The success rate onthe battlefield may be much lower. Sometimes Army medics are only abouttwenty-nine percent successful in starting an IV line during battlefieldconditions. These patients are often probed repeatedly with sharpneedles in an attempt to solve this problem and may require an invasiveprocedure to finally establish intravenous access.

In the case of patients with chronic disease or the elderly,availability of easily accessible veins may be depleted. Other patientsmay have no available IV sites due to anatomical scarcity of peripheralveins, obesity, extreme dehydration or previous IV drug use. For suchpatients, finding a suitable site for administering lifesaving therapyoften becomes a monumental and frustrating task. While morbidity andmortality statistics are not generally available, it is generally knownthat many patients with life threatening emergencies have died becauseaccess to the vascular system with lifesaving IV therapy was delayed orsimply not possible.

The intraosseous (IO) space provides a direct conduit to a patient'svascular system and provides an attractive alternate route to administerIV drugs and fluids. Intraosseous infusion has long been the standard ofcare in pediatric emergencies when rapid IV access is not possible. TheU.S. military used hand driven IO needles for infusions extensively andsuccessfully during World War II. However, such IO needles werecumbersome, difficult to use, and often had to be manually driven into abone.

Drugs administered intraosseously enter a patient's blood circulationsystem as rapidly as they do when given intravenously. In essence, bonemarrow may function as a large non-collapsible vein.

SUMMARY OF THE DISCLOSURE

In accordance with teachings of the present disclosure, apparatus andmethods to access bone marrow at various target areas such as a humansternum are provided. The apparatus and methods may include, but are notlimited to, guide mechanism and/or templates to position an intraosseousdevice at a selected insertion site and to control depth of penetrationinto associated bone marrow. For some embodiments, such apparatus mayinclude an intraosseous (IO) device operable to penetrate the sternum, adriver operable to insert the IO device into the sternum, and a depthcontrol mechanism operable to limit depth of penetration of the IOdevice into the sternum. The IO device may include an outer cannula andan inner trocar. The IO device may also include a soft tissue penetratorand a fluid connector such as a Luer lock connection. The depth controlmechanism may include a removable collar or a collar permanentlyattached to portions of the IO device.

The present disclosure may provide for some applications a manualdriver, an IO needle set, a guide to position the IO needle set at aninjection site and/or a depth control mechanism to limit depth ofpenetration of the IO needle set into bone marrow in a sternum.

Various aspects of the present disclosure may be described with respectto providing IO access at selected sites in a patient's sternum. Theupper tibia proximate a patient's knee may be used as an insertion sitefor an IO device to establish access with a patient's vascular system inaccordance with teachings of the present disclosure. The humerus in apatient's arm may also be used as an insertion site for IO access to apatient's vascular system in accordance with teachings of the presentdisclosure.

For some applications a removable guide and/or depth control mechanismmay be provided to allow a relatively long intraosseous deviceappropriate for insertion at a tibia or humerus to also besatisfactorily inserted into a sternum. Typically intraosseous devicesused to access sternal bone marrow are relatively short as compared tointraosseous devices used to access bone marrow proximate a tibia orhumerus.

Insertion sites and target areas for successful placement of an IOdevice in a patient's sternum may be larger than target areas forplacement of IV devices. However, the use of guide mechanisms and/ordepth control mechanisms incorporating teachings of present disclosuremay be desired when an IO device is inserted in close proximity to apatient's heart, lungs and associated blood vessels. Guide mechanisms,depth control mechanisms and various techniques incorporating teachingsof the present disclosure may substantially reduce and/or eliminatepotential problems associated with inserting an intraosseous device intoa patient's sternum during difficult emergency conditions and/or fieldoperating environments.

One aspect of the present disclosure may be a method of establishingaccess to an intraosseous space or target area including contacting skinand other soft tissue covering an insertion site with a scalpel or bladeto form an incision in the skin and other soft tissue. Apparatusincluding a driver, an IO needle set and a depth control mechanism maybe used to provide access to an intraosseous space or target areaadjacent to the insertion site. Portions of the IO needle set and thedepth control mechanism may be inserted into the incision. The drivermay then be used to insert portions of the IO needle set to a desireddepth in the intraosseous space or target area. For some applications amanual driver may be releasably engaged with an IO needle setincorporating teachings of the present disclosure. For otherapplications a manual driver may be permanently attached to or formed asan integral component of a portion of the IO needle set.

Teachings of the present disclosure are not limited to providing IOaccess in a sternum. Various teachings of the present disclosure may beused to provide IO access to other target areas and may also be usedduring treatment of animals in a veterinary practice.

BRIEF DESCRIPTION OF THE DRAWINGS

A more complete and thorough understanding of the present embodimentsand advantages thereof may be acquired by referring to the followingdescription taken in conjunction with the accompanying drawings, inwhich like reference numbers indicate like features, and wherein:

FIG. 1 is a schematic drawing showing portions of a human sternum andattached ribs;

FIG. 2A is a schematic drawing showing apparatus operable to access bonemarrow in accordance with teachings of the present disclosure;

FIG. 2B is a schematic drawing showing an exploded view of the apparatusshown in FIG. 2A;

FIG. 2C is a schematic drawing showing an exploded, isometric view withportions broken away of one example of connectors operable to releasablyengage a driver with an intraosseous device;

FIG. 3A is a schematic drawing showing an isometric view of an alternateembodiment of apparatus operable to form an incision in soft tissue andto access sternal bone marrow;

FIG. 3B is a schematic drawing in section taken along lines 3B-3B ofFIG. 3A;

FIG. 3C is a schematic drawing in section with portions broken away ofthe apparatus of FIG. 3A, wherein the soft tissue penetrator has formedan incision in skin, muscle or other soft tissue prior to inserting anintravenous device through portions of an anterior cortex and enteringan adjacent intraosseous space;

FIG. 4 is a schematic drawing in section with portions broken awayshowing an intravenous device inserted to a controlled depth intosternal bone marrow in accordance with teachings of the presentdisclosure;

FIG. 5A is a schematic drawing in section with portions broken awayshowing another example of an intraosseous device inserted at a firstintersection site to a controlled depth in sternal bone marrow inaccordance with teachings of the present disclosure;

FIG. 5B is a schematic drawing in section with portions broken awayshowing the intraosseous device of FIG. 5A inserted at a secondinsertion site to approximately the same controlled depth in sternalbone marrow as shown in FIG. 5A in accordance with teachings of thepresent disclosure;

FIG. 5C is a schematic drawing showing an exploded view of apparatusoperable to access bone marrow of a sternum in accordance with teachingsof the present disclosure;

FIG. 5D is a schematic drawing showing an exploded view of anotherexample of apparatus operable to access bone marrow in accordance withteachings of the present disclosure;

FIG. 6A is a schematic drawing showing one example of packaging for anIO needle set operable to penetrate a bone and associated bone marrowalong with a scalpel operable to form an incision in soft tissuecovering an insertion site;

FIG. 6B is a schematic drawing showing another example of packaging foran IO needle set operable to penetrate a bone and associated bone marrowalong with a scalpel operable to form an incision in soft tissuecovering an insertion site;

FIG. 6C is a schematic drawing showing still another example ofpackaging for an IO needle set operable to penetrate a bone andassociated bone marrow along with a scalpel operable to form an incisionin soft tissue covering an insertion site;

FIG. 7 is a schematic drawing showing an isometric view of apparatusoperable to guide penetration of an IO needle set into bone marrow andto limit the depth of such penetration into the bone marrow inaccordance with teachings of the present disclosure;

FIG. 8A is a schematic drawing in section with portions broken away ofan incision made in soft tissue covering a selected insertion site forinserting an IO needle set into a target area in accordance withteachings of the present disclosure;

FIG. 8B is a schematic drawing in section with portions broken awayshowing one example of a combined guide and/or depth control mechanismincorporating teachings of the present disclosure disposed in softtissue at the insertion site shown in FIG. 8A; and

FIG. 8C is a schematic drawing in section with portions broken awayshowing portions of an IO needle set disposed in bone marrow at thetarget area in accordance with teachings of the present disclosure.

DETAILED DESCRIPTION OF THE DISCLOSURE

Some preferred embodiments of the disclosure and associated advantagesmay be best understood by reference to FIGS. 1-8C wherein like numbersrefer to same and like parts.

Vascular system access may be essential for treatment of many seriousdiseases, chronic conditions and acute emergency situations. Yet, manypatients experience extreme difficulty obtaining effective treatmentbecause of inability to obtain or maintain intravenous (IV) access. Anintraosseous (IO) space provides a direct conduit to a patent's vascularsystem and systemic circulation. Therefore, IO access is an effectiveroute to administer a wide variety of drugs, other medications andfluids. Rapid IO access offers great promise for almost any seriousemergency that requires vascular access to administer life saving drugs,other medications and/or fluids when traditional IV access is difficultor impossible.

An intraosseous space may generally be described as region wherecancellous bone and associated medullary cavity combine. Bone marrowtypically includes blood, blood forming cells, and connective tissuefound in an intraosseous space surrounded by compact bone. For purposesof illustration, compact bone disposed nearer the anterior or dorsalsurface shall be referred to as “anterior compact bone” or “anteriorbone cortex.” Compact bone disposed farther from the dorsal or anteriorsurface may be referred to as “posterior compact bone” or “posteriorbone cortex.”

IO access may be used as a “bridge” (temporary fluid and drug therapy)during emergency conditions until conventional IV sites can be found andused. Conventional IV sites often become available because fluids and/ormedication provided via IO access may stabilize a patient and expandveins and other portions of a patient's vascular system. IO devices andassociated procedures incorporating teachings of the present disclosuremay become standard care for administering medications and fluids insituations when IV access is difficult or not possible.

Intraosseous access may be used as a “routine” procedure with chronicconditions which substantially reduce or eliminate availability ofconventional IV sites. Examples of such chronic conditions may include,but are not limited to, dialysis patients, patients in intensive careunits and epilepsy patients. Intraosseous devices and associatedapparatus incorporating teachings of the present disclosure may bequickly and safely used to provide IO access to a patient's vascularsystem in difficult cases such as status epilepticus to give medicalpersonnel an opportunity to administer crucial medications and/orfluids. Further examples of such acute and chronic conditions are listednear the end of this written description.

The term “driver” may be used in this application to include any type ofpower driver or manual driver satisfactory for inserting an intraosseous(IO) device such as a penetrator assembly or an IO needle into selectedportions of a patient's vascular system. Various techniques may besatisfactorily used to releasably engage or attach an IO device and/orpenetrator assembly with manual drivers and power drivers.

For some applications a manual driver may be securely attached to aportion of an IO device or may be formed as an integral component of anIO device. For some applications a power driver or a manual driver maybe directly coupled with an IO device. Various types of connectors mayalso be used to releasably couple a manual driver or a power driver withan IO device. A wide variety of connectors and associated connectorreceptacles, fittings and/or other types of connections with variousdimensions and configurations may be satisfactorily used to engage an IOdevice with a power driver or a manual driver.

The term “intraosseous (IO) device” may be used in this application toinclude any hollow needle, hollow drill bit, penetrator assembly, bonepenetrator, catheter, cannula, trocar, inner penetrator, outerpenetrator, IO needle or IO needle set operable to provide access to anintraosseous space or interior portions of a bone. A wide variety oftrocars, spindles and/or shafts may be disposed within a cannula duringinsertion at a selected insertion site. Such trocars, spindles andshafts may also be characterized as inner penetrators. A catheter,cannula, hollow needle or hollow drill bit may sometimes becharacterized as an outer penetrator.

For some applications a layer or coating (not expressly shown) of ananticoagulant such as, but not limited to, heparin may be placed oninterior and/or exterior portions of a catheter or cannula to preventthrombotic occlusion of the catheter or cannula. Anticoagulants mayreduce platelet adhesion to interior surfaces of the catheter or cannulaand may reduce clotting time of blood flowing into and through thecatheter or cannula. Placing a layer of an anticoagulant on the exteriorof a catheter or cannula adjacent to an associated tip may be helpful toprevent clotting.

The term “fluid” may be used in this application to describe any liquidincluding, but not limited to, blood, water, saline solutions, IVsolutions, plasma or any mixture of liquids, particulate matter,dissolved medication and/or drugs appropriate for injection into bonemarrow or other insertion sites. The term “fluid” may also be usedwithin this patent application to include body fluids such as, but notlimited to, blood and cells which may be withdrawn from a insertionsite.

Various features of the present disclosure may be described with respectto manual drivers 20, 20 a and 20 d. Various features of the presentdisclosure may also be described with respect to intraosseous devices160, 160 a and 160 b. However, guide and/or depth control mechanisms andinsertion techniques incorporating teachings of the present disclosuremay be satisfactorily used with a wide variety of drivers andintraosseous devices. The present disclosure is not limited to use withintraosseous devices 160, 160 a, 160 b, 160 c or 160 d or drivers 20, 20a, or 20 d.

Power driver (not expressly shown) may include a housing with varioustypes of motors and/or gear assemblies disposed therein. A rotatableshaft (not expressly shown) may be disposed within the housing andconnected with a gear assembly (not expressly shown). Various types offittings, connections, connectors and/or connector receptacles may beprovided at one end of the rotatable shaft extending from a power driverfor releasable engagement with an IO device.

Examples of power drivers are shown in patent application Ser. No.10/449,503 filed May 30, 2003 entitled “Apparatus and Method to ProvideEmergency Access To Bone Marrow,” now U.S. Pat. No. 7,670,328; Ser. No.10/449,476 filed May 30, 2003 entitled “Apparatus and Method to AccessBone Marrow,” now U.S. Pat. No. 7,699,850; and Ser. No. 11/042,912 filedJan. 25, 2005 entitled “Manual Intraosseous Device,” and published asPub. No. US 2005/0165404.

FIG. 1 shows portions of a bone structure associated with a humansternum. The bone structure shown in FIG. 1 may sometimes be referred toas the sternocostal region. Sternum 90 and associated pairs or sets ofribs 98 a-98 j form portions of a human rib cage. Sternum 90 as shown inFIG. 1 may be generally described as a flat, dagger-shaped bone. Sternum90 may also be described as having three segments, manubrium 92,gladiolus 94, and xiphoid process 96.

Manubrium 92, connected to gladiolus 94, may sometimes be referred to as“the handle.” Gladiolus 94 may sometimes be referred to as the body or“blade” of sternum 90. Xiphoid process 96 may be referred to as “thetip” of sternum 90. Xiphoid process 96 may be initially formed fromcartilage but generally becomes boney in later years. Manubrium 92,gladiolus 94 and xiphoid process 96 are generally fused with each otherin adults.

Two pairs or sets of ribs 98 a and 98 b may be attached to manubrium 92.Gladiolus 94 may be connected directly to third through seventh pairs orsets of ribs 98 c-98 i and indirectly to eighth pair or set of ribs 98j. Floating ribs are not shown in FIG. 1.

Sternum 90 may include insertion site 100 in manubrium 92 and insertionsite 102 in gladiolus 94 for accessing bone marrow disposed therein. SeeFIGS. 3C, 4, 5A, 5B and 8C. Sternal notch 104 formed in manubrium 92 maybe used with a guide mechanism incorporating teachings of the presentdisclosure to position an intraosseous device for insertion at insertionsite 100 or 102.

Apparatus incorporating teachings of the present disclosure may includea driver operable to insert at least a portion of an IO device into anintraosseous space. Guide mechanisms and/or depth control mechanismsincorporating teachings of the present disclosure may also be providedwhen the IO device is inserted into a sternum or other target areas withlimited space for penetration by the IO device. Examples of suchmechanisms may include, but are not limited to, collar 170 shown inFIGS. 2A and 2B, collar 170 a shown in FIG. 3B, guide 40 shown in FIGS.3A and 3C, collar 170 b shown in FIGS. 4, 5A and 5B and combined guideand depth control mechanism 60 with collar 62 shown in FIGS. 7, 8A, 8Band 8C. Combined guide and depth control mechanisms may sometimes bereferred to as removable collars.

FIGS. 2A, 2B and 2C show one example of a manual driver and associatedintraosseous device which may be used to provide vascular access inaccordance with teachings of the present disclosure. Manual driver 20may include handle 22 with a plurality of finger grips or finger rests24 formed in the exterior thereof. Handle 22 may have a generally domeshaped configuration compatible with engagement by the palm (notexpressly shown) of an operator's hand (not expressly shown). Domeshaped portion 26 of handle 22 and finger grips or finger rests 24 mayhave ergonically satisfactory designs.

As shown in FIGS. 2B and 2C connector 30 may extend from surface 28 ofhandle 22 opposite from dome shaped portion 26. Connector 30 may includedrive shaft 32 extending therefrom. See FIG. 2C. Connector 30 may alsoinclude a plurality of tapered cylindrical segments 34 extending fromsurface 28 of handle 22 opposite from dome shaped portion 26. Eachsegment 34 may be sized to fit within corresponding void space oropening 138 formed in first end 181 of connector 180.

For embodiments such as shown in FIGS. 2A, 2B, 2C, 6A, 6B and 6C,intraosseous device or penetrator assembly 160 may include connector180, associated hub 200, outer penetrator 210 and inner penetrator 220.Penetrator assembly 160 may include an outer penetrator such as acannula, hollow tube or hollow drill bit and an inner penetrator such asa stylet or trocar. Various types of stylets and/or trocars may bedisposed within an outer penetrator.

For some applications connector 180 may be described as having agenerally cylindrical configuration defined in part by first end 181 andsecond end 182. SEE FIG. 2B. Exterior portions of connector 180 mayinclude an enlarged tapered portion adjacent to end 181. A plurality oflongitudinal ridges 190 may be formed on the exterior of connector 180to allow an operator to grasp associated penetrator assembly 160 duringattachment with a drive shaft. See FIG. 2A. Longitudinal ridges 190 alsoallow connector 180 to be grasped for disengagement from hub 200 whenouter penetrator 210 has been inserted into a bone and associated bonemarrow.

First end 181 of connector of 180 may included opening 186 sized toreceive portions drive shaft 32 therein. A plurality of webs 136 mayextend radiantly outward from connector receptacle 186. Webs 136cooperate with each other to form a plurality of openings 138 adjacentto first end 181. Opening 186 and openings 138 cooperate with each otherto form portions of a connector receptacle operable to receiverespective portions of connector 30 therein.

Second end 182 of connector 180 may include an opening (not expresslyshown) sized to receive first end 201 of hub 200, 200 a or 200 btherein. Threads (not expressly shown) may be formed in the openingadjacent to second end 182 of connector 180. Such threads may be used toreleasably attach connector 180 with threads 208 disposed adjacent tofirst end 201 of hubs 200, 200 a and 200 b. See FIGS. 4, 5A and 5B.

Respective first end 201 of hub 200 may have a generally cylindrical pintype configuration compatible with releasable engagement with second endor box end 182 of connector 180. For some applications first end 201 andthreads 208 may provide portion of a Luer lock connection. Various typesof Luer lock connections may be formed on first end 201 of hub 200 foruse in to releasably engage tubing and/or other medical devices (notexpressly shown) with hub 200 after intraosseous device 160 had beeninserted into bone marrow at a target area and inner penetrator 220removed from outer penetrator 210.

Metal disc 158 may be disposed within opening 186 for use in releasablyattaching connector 180 with a magnetic drive shaft. See FIGS. 3C and8C. For some applications, drive shaft 32 may be magnetized. End 223 ofinner penetrator 220 may be spaced from metal disc 158 with insulatingor electrically nonconductive material disposed there between.

For some applications outer penetrator or cannula 210 may be describedas a generally elongated tube sized to receive inner penetrator orstylet 220 therein. Portions of inner penetrator 220 may be slidablydisposed within a longitudinal passageway (not expressly shown)extending through outer penetrator 210. The outside diameter of innerpenetrator 220 and the inside diameter of the longitudinal passagewaymay be selected such that inner penetrator 220 may be slidably disposedwithin outer penetrator 210.

Tip 211 of outer penetrator 210 and/or tip 222 of inner penetrator 220may be operable to penetrate bone and associated bone marrow. Theconfiguration of tips 211 and/or 222 may be selected to penetrate a boneor other body cavities with minimal trauma. First end or tip 222 ofinner penetrator 220 may be trapezoid shaped and may include one or morecutting surfaces. In one embodiment outer penetrator 210 and innerpenetrator 220 may be ground together as one unit during an associatedmanufacturing process. Providing a matching fit allows respective tips211 and 222 to act as a single drilling unit which facilitates insertionand minimizes damage as portions of penetrator assembly 160 are insertedinto a bone and associated bone marrow.

Inner penetrator 220 may also include a longitudinal groove (notexpressly shown) that runs along the side of inner penetrator 220 toallow bone chips and/or tissues to exit an insertion site as penetratorassembly 160 is drilled deeper into an associated bone. Outer penetrator210 and inner penetrator 220 may be formed from stainless steel,titanium or other materials of suitable strength and durability topenetrate bone.

For some applications a depth control mechanism incorporating teachingsof the present disclosure, such as collar 170, may be disposed on andengaged with exterior portions of outer penetrator 210. For otherapplications a depth control mechanism such as collar 170 a and exteriorportions of outer penetrator 210 may be operable to rotate relative toeach other. For still other applications a depth control mechanism suchas collar 170 b may be formed as part of associated hub 200 a or 200 b.See FIGS. 4, 5A AND 5B. For still further applications a removable depthcontrol mechanism such as collar 62 may be used. See FIGS. 7, 8B and 8C.Collars 170, 170 a, 170 b and 62 may sometimes be referred to as “depthcontrol limiters.”

For some embodiments collar 170 may have a generally elongated, hollowconfiguration compatible with engaging the outside diameter of outerpenetrator 210. One end of collar 170 (not expressly shown) may beinstalled over exterior portions of outer penetrator 210 and disposedwithin adjacent portions of hub 200. Second end 172 of collar 170 mayextend a selected distance from flange 202 of hub 200. Varioustechniques such as, but not limited to, press fitting may be used toinstall collar 170 on exterior portions of outer penetrator 210.

The resulting spacing between second end 202 of hub 200 and second end172 of collar 170 may limit depth of penetration of outer penetrator 210into bone and associated bone marrow. Second end 202 of hub 200 andsecond end 172 of collar 170 may cooperate with each other to provide adepth limiting mechanism for associated intraosseous device orpenetrator assembly 160. Collar 170 may be formed from various materialsincluding stainless steel, titanium or other materials used to formouter penetrator 210.

Collar 170 will generally be securely engaged with the exterior of outerpenetrator 210. As a result outer penetrator 210 and collar 170 willgenerally rotate with each other in response to rotation of manualdriver 20. For other applications portions of an intraosseous device andan associated depth control mechanism may be operable to rotate relativeto each other during insertion of the intraosseous device into bonemarrow adjacent to a selected insertion site. See for example FIG. 3C.

Hubs 200, 200 a and 200 b may be used to stabilize respective penetratorassemblies 160 and 160 b during insertion of an associated penetratorinto a patient's skin, soft tissue and adjacent bone at a selectedinsertion site. SEE FIGS. 4, 5A and 5B. Hubs 200, 200 a and 200 b mayalso be used as a handle to manipulate outer penetrator 210 or removeouter penetrator 210 from a target area. Respective first end 201 of hub200 and 200 b may be operable for releasable engagement or attachmentwith associated connector 180.

Passageway 206 may extend from first end 201 through second end 202. SEEFIGS. 4, 5A AND 5B. The inside diameter of passageway 206 may beselected to securely engage the outside diameter of penetrator 210. Thedimensions and configuration of passageway 206 may be selected tomaintain associated outer penetrator 210 engaged with hub 200.

Second end 202 of hubs 200, 200 a and 200 b may have a size andconfiguration compatible with an insertion site for an associatedpenetrator assembly. The combination of hub 200 with outer penetrator210 and inner penetrator 220 may sometimes be referred to as a“penetrator set” or “intraosseous needle set”.

For some applications end 202 of hubs 200, 200 a and 200 b may have thegeneral configuration of a flange. An angular slot or groove sized toreceive one end of protective cover 233 (See FIG. 5C) or needle cap 234(See FIG. 5D) may be formed in end 202. For example, slot or groove 204as shown in FIG. 8C may be used to releasably engage cover 234 withpenetrator assembly 160. Cover 233 as shown in FIG. 5C may include anenlarged inside diameter compatible with the outside diameter of collar170. Cap 234 as shown in FIG. 5D may have a smaller inside diametercompatible with the exterior of outer cannula 210.

Protective cover 233 may be described as a generally hollow tube with aninside diameter compatible with the outside diameter of collar 170. Thelength of protective cover 233 may be greater than the distance betweenend 202 of hub 200 and the extreme end of tip 211. For some applicationsprotective cover 233 may be formed by cutting plastic tubing (notexpressly shown) having an appropriate inside diameter into segmentshaving a desired length.

Needle cap 234 may be described as a generally hollow tube havingclosed, rounded end 232. See FIG. 5D. Cover 234 may be disposed withinassociated slot 204 to protect portions of outer penetrator 210 andinner penetrator 220 prior to attachment with an associated driver.Cover 234 may include a plurality of longitudinal ridges 236 whichcooperate with each other to allow installing and removing cover orneedle cap 234 without contaminating portions of an associatedpenetrator.

The dimensions and configuration of second end 202 of hubs 200, 200 a or200 b may be varied to accommodate various insertion sites and/orpatients. Hubs 200, 200 a and 200 b may be satisfactorily used with awide variety of flanges or other configurations compatible forcontacting a patient's skin. Also, second end 202 and associated flangemay be used with a wide variety of hubs. The present disclosure is notlimited to hubs 200, 200 a or 200 b, end 202 or the associated flange.

For some applications intraosseous device 160 may be described as a one(1″) inch needle set. Collar 170 may have a diameter of approximatelyfour (4 mm) or five (5 mm) millimeters. When used as a sternalintraosseous device for some adults, the distance between second end 202of hub 200 and the extreme end of tip 211 may be approximately twentyfive (25.0 mm) millimeters. The distance between second end 172 ofcollar 170 and the extreme end of tip 211 maybe approximately eight (8)millimeters. As a result the distance between second end 202 and of hub200 and second end 172 of collar 170 may be approximately seventeen(17.0 mm) millimeters.

For some applications second end 172 of collar 170 may have an effectivesurface area large enough to support up to fifty pounds of force withoutsecond end 172 of collar 170 penetrating compact bone surrounding anintraosseous space. See for example FIGS. 4, 5A and 5B.

One of the benefits of the present disclosure includes the ability tovary the depth of penetration of an intraosseous device into associatedbone and bone marrow. For example spacing between second end 172 ofcollar 170 and the extreme of tip 211 may be increased or decreased byvarying the overall length of collar 170.

Penetrators may be provided in a wide variety of configurations andsizes depending upon intended clinical purposes for insertion of theassociated penetrator. Outer penetrators may be relatively small forpediatric patients, medium size for adults and large for oversizeadults. By way of example, an outer penetrator may range in length fromfive (5) mm to thirty (30) mm. The diameter of an outer penetrator mayrange from eighteen (18) gauge to ten (10) gauge.

The length and diameter of an outer penetrator used in a particularapplication may depend on the size of a bone to which the apparatus maybe applied. For example the length of outer penetrator 210 and innerpenetrator 220 may be selected for compatibility with a typical adulttibia or humerus, approximately one (1″) inch. Placing collar 170 onexterior portions of outer penetrator 210 allows the same penetrators210 and 220 to be satisfactorily used to access bone marrow in an adultsternum by limiting the depth of penetration to approximately eight (8)millimeters.

For some applications a guide mechanism or template incorporatingtechnique of the present disclosure may be provided to assist withinserting an intraosseous device at a selected insertion site. Forembodiments such as shown in FIGS. 3A, 3B and 3C guide mechanism ortemplate 40 may be generally described as having first portion or base41 with second portion 42 extending therefrom. The configuration anddimensions associated with first portion or base 41 may be selected tobe compatible with placing guide mechanism 40 on a patient's chest.

First portion 41 may have a general circular configuration withelongated segment 43 extending therefrom. Notch 44 may be formedadjacent extreme end 45 of elongated segment 43. The dimensions andconfiguration of notch 44 may be selected to be compatible with sternalnotch 104 formed in manubrium 92.

First portion 41 of guide mechanism or template 40 may include surface47 compatible with contacting a sternum or other insertion site. Opening49 may be formed in first surface 47 and may extend therethrough. Thedimensions and configuration of opening 49 may be selected to becompatible with the exterior dimensions of intraosseous device 160 a.

Second portion 42 of guide mechanism or template 40 may be disposedadjacent to opening 49 and extend from base 41 opposite surface 47.Generally elongated cylindrical cavity 50 may be formed in secondportion 42 and may be aligned with opening 49 in first portion 41. Thedimensions and configuration of cylindrical cavity 50 and opening 49 maybe selected to be compatible with placing connector 180 and hub 200 ofintraosseous device 160 a therein. For embodiments such as shown in FIG.3C second end 202 of hub 200 may be generally aligned with exteriorsurface 47 of first portion 41.

Handle 22 a may include generally circular recess or cavity 36 extendingfrom second surface 28 a. The dimensions and configuration of recess orcavity 36 may be selected to be compatible with placing end 48 of secondportion 42 therein. End 48 of second portion 42 may include opening 52.

The dimensions and configuration of opening 52 may be selected to allowinserting portions of drive shaft 32 therethrough. The dimensions andconfiguration of recess portion or cavity 36 in handle 22 a and exteriordimensions of second portion 42 adjacent to end 48 may be selected toallow handle 22 a to rotate drive shaft 32 and attach intraosseousdevice 160 a while guide mechanism 40 is held in a generally fixedposition with notch 44 aligned with sternal notch 104.

For some applications the finger of an operator (not expressly shown)may be placed in contact with both notch 44 and sternal notch 104 whilerotating handle 22 a to insert portions of penetrator assembly 160 a ata desired insertion. The spacing between notch 44 and the center ofcavity 50 may be selected to be approximately equal the space betweensternal notch 104 and the center of insertion site 100 or insertion site102. For embodiments such as shown in FIG. 3C the spacing between notch44 and the center of cavity 50 may be approximately two centimeters.This spacing may be selected to be compatible with insertion site 100 inmanubrium 92.

For some applications notch 44 may be used to position guide mechanism40 and intraosseous device 160 a within insertion site 100 in manubrium92. For other applications the length of segment 43 may be increasedsuch that notch 44 may be satisfactorily used to position guidemechanism 40 and intraosseous device 160 a within insertion site 102 ofgladiolus 94.

For embodiments such as shown in FIG. 3C manubrium 92 may includeanterior cortex 106, posterior cortex 110 with bone marrow 108 disposedthere between. As shown in FIGS. 3A, 3B and 3C, intraosseous device 160a may have similar features and characteristics as previously describedfor intraosseous device 160 except for modifications to hub 200 a andcollar 170 a. For example, collar 170 a may be formed from the same orsimilar materials as used to form collar 170 or may be formed frommaterials the same or similar to hub 200 a. Collar 170 a may have aninside diameter larger than the outside diameter of outer penetrator210. The difference in diameter may result in forming annular space 250between the exterior of outer penetrator 210 and interior of collar 170a. See FIGS. 3B and 3C.

For some applications first end 171 a of collar 170 a may be rotatablyengaged with adjacent portions of hub 200 a. For embodiments such asshown in FIGS. 3A, 3B and 3C annular recess or annular groove 214 may beformed in hub 200 a spaced from second end 202 a. First end 171 a mayinclude annular projection or annular flange 174 extending radiallytherefrom. The configuration and dimensions of flange 174 may beselected to be smaller than corresponding configuration and dimensionsof annular recess 214. As a result, intraosseous device 160 a andparticularly hub 200 a may rotate relative to collar 170 a and first end171 a.

For some applications one or more blades 176 may be disposed inrespective slots formed adjacent to second end 172 of collar 170. Blades176 may be used to form a small incision in skin 80 and muscle or othersoft tissue 82 covering insertion site 100 on manubrium 92 or any otherinsertion site. The dimensions and configuration of blades 176 may beselected to provide a properly sized incision to accommodate insertingremovable collar 170 a therethrough. Blades 176 remain generallystationary relative to collar 170 a. Blades 176 may also be spaced fromthe exterior of outer penetrator 210 to accommodate rotation of outerpenetrator 210 during insertion into bone marrow 108.

Manual driver 20 a may be used to insert intraosseous device 160 a intobone marrow 108 until second end 172 contacts adjacent portions ofanterior cortex layer 106. As a result of annular space 250 formedbetween exterior portions of outer penetrator 210 and collar 170 aincluding attached blades 176 and by rotatably attaching first end 171 aof collar 170 a with annular recess 214 of hub 200, collar 170 a andassociated blades 176 may remain in a relatively fixed location whileinserting intraosseous device 160 a into associated bone marrow. Annularspace 250 and the rotatable connection at first end 171 a help to limitany additional cutting or tearing of skin 80 and soft tissue 82 duringrotation of intraosseous device 160 a.

For some applications a spring or other mechanism (not expressly shown)may be disposed within handle 22 a to assist with rotation ofintraosseous device 160 a. Various types of trigger mechanisms (notexpressly shown) may also be provided to allow rotation of drive shaft32 when guide mechanism 40 has been disposed over a desired insertionsite.

For embodiments such as shown in FIGS. 4, 5A and 5B collar 170 b may beformed as an integral component of associated hub 200 b or 200 c. Forsuch embodiments collar 170 b may be formed from the same or similarmaterials used to form other portions of associated hubs 200 b and 200c. For some applications collar 170 b may be formed as a separatecomponent and a first end of collar 170 b (not expressly shown) may besecurely engaged with adjacent portions of hubs 200 b or 200 c. Collar170 b may include inside diameter 178 compatible with contactingexterior or outside diameter portions of outer penetrator 210.

For embodiments such as shown in FIG. 4, the length of collar 170 bextending from second end or flange 202 may be selected to provide anoptimum spacing between second end 172 and second end 202 of hub 200 bcorresponding with an “average” thickness of skin, muscle and other softtissue covering an adult sternum. The spacing between second end 172 ofcollar 170 b and the extreme end of tip 211 of outer penetrator 210remains fixed or constant for hub 200 b. As discussed later, this samespacing may be variable to allow hub 200 c to accommodate injectionsites having variations in thickness of skin 80 and soft tissue 82covering each injection site. Second end 172 of collar 170 b may provideportions of a depth control mechanism for outer penetrator 210 extendingfrom hub 200 b.

For embodiments such as shown in FIGS. 5A and 5B hub 200 c may be formedfrom first segment 261 and second segment 262. First segment 261 mayinclude first end 201 with first longitudinal bore 206 extendingtherethrough. Outer penetrator 210 may be securely engaged with firstsegment 261. Second segment 262 may include second end 202 of hub 200 c.Second segment 262 may be generally described as having longitudinalbore 264 extending therethrough.

As shown in FIGS. 5A and 5B first segment 261 may have exteriordimensions sized to fit within second longitudinal bore 264 of secondsegment 262. First threads 268 may be formed on exterior portions offirst segment 261. Second threads 270 may be formed on interior portionsof second longitudinal bore 264 of second segment 262. First threads 268and second threads 270 may have matching thread profiles. As a resultthreads 268 of first portion 261 of hub 200 b may be engaged withthreads 270 of second portion 262.

Rotation of first segment 261 relative to second segment 262 may be usedto vary spacing between second end 172 of collar 170 b and associatedsecond end or flange 202 of hub 200 c. Compare FIGS. 5A and 5B with eachother. As a result, hub 200 c may be used at various injection sites andtarget areas and/or may be used with patients having increasing ordecreasing thickness of soft tissue covering an insertion site ascompared with an average thickness for an adult sternum.

For some applications the length of collar 170 b extending from secondend 202 of hub 200 c may be increased as compared with the length ofcollar 170 b extending from hub 200 b. The increased length of collar170 b may be used to accommodate soft tissue 82 b which is thicker thansoft tissue 82 as shown in FIG. 4. Intraosseous device 160 c andparticularly hub 200 c may also be satisfactorily used at injectionsites which have a reduced thickness of skin and soft tissue covering aninjection site. See for example FIG. 5B. For this embodiment thethickness of muscle and other soft tissue 82 c may be less than the“average” thickness shown in FIG. 4. When intraosseous device 160 c isinitially installed at an insertion site such as shown in FIG. 5A, a gapor space would be apparent between second 202 and skin 80. The threadedconnection formed between first segment 261 and second segment 262allows rotation of second segment 262 until second surface or flange 202contacts skin 80 at the injection site. See FIG. 5B. As a result, hub200 c may provide desired stabilization for outer penetrator 210 andother portions of intraosseous device 160 c at insertion sites withvariations from “average” thickness of skin and other soft tissuecovering the insertion site.

FIG. 5C shows one example of an intraosseous device incorporatingteachings of the present disclosure operable to provide intraosseousaccess to bone marrow disposed in a sternum. Intraosseous device 160 das shown in FIG. 5C may include connector 180, hub 200, collar 170,outer penetrator 210 and inner penetrator 220 as previously describedwith respect to FIGS. 2A, 2B and 2C.

For some applications manual driver 20 d may be securely engaged withintraosseous device 160 d. Manual driver 20 d may also havesubstantially reduced dimensions as compared with manual drivers 20 and20 a. Reducing the dimensions and configuration associated with manualdriver 20 d may limit the amount of force which may be applied tointraosseous device 160 d by personnel trying to obtain IO access tosafe levels, particularly during an emergency or other stressfulconditions.

For embodiments such as shown in FIG. 5C manual driver 20 d may includehandle 22 d defined in part by generally dome shaped portion orspherical portion 26 d extending from surface 28 d. For someapplications exterior dimensions and configuration of surface 28 d maybe approximately equal to the dimensions and configuration of first end181 of associated connector 180. For example, the diameter of surface 28d may correspond approximately with the diameter of spherical portion 26d and may also approximately equal the diameter of first end 181 ofconnector 180. See arrow 226 d in FIG. 5C. Spherical portion 26 d mayalso be formed as an integral component of connector 180 (not expresslyshown) opposite from end 182. Such embodiments would not includerespective surfaces 28 d and 181.

FIG. 5D shows another example of an intraosseous device incorporatingteachings of the present disclosure operable to provide intraosseousaccess to bone marrow adjacent to a selected insertion site.Intraosseous device 160 e as shown in FIG. 5D may include connector 180,hub 200, outer penetrator 210 and inner penetrator 220 as previouslydescribed with respect to FIGS. 2A, 2B, 2C and 5C. However, intraosseousdevice 160 e does not include collar 170. As a result, intraosseousdevice 160 e may be used at locations other than a sternum. Suchlocations may include, but are not limited to, a humerus or upper tibia.

For some applications manual driver 20 e may be securely engaged withintraosseous device 160 e. Manual driver 20 e may also havesubstantially reduced dimensions as compared with manual drivers 20 and20 a. However, the dimensions of manual driver 20 e may be larger thancorresponding dimensions of driver 20 d. As a result, manual driver 20 emay accommodate inserting intraosseous device 160 e at locations such asa humerus or upper tibia. Manual driver 20 e may allow applying moreforce to intraosseous device 160 e than manual driver 20 d may beoperable to apply to intraosseous device 160 d.

For embodiments such as shown in FIG. 5D manual driver 20 e may includehandle 22 e defined in part by generally dome shaped portion orspherical portion 26 e extending from surface 28 e. For someapplications exterior dimensions and configuration of surface 28 e maybe approximately equal to the dimensions and configuration of first end181 of associated connector 180. For example, the diameter of surface 28e may be approximately equal to the diameter of first end 181 ofconnector 180. However, the diameter of spherical portion 26 e may belarger than the diameter of surface 28 e or first end 181. See arrow 226e in FIG. 5D. Spherical portion 26 e may also be formed as an integralcomponent of connector 180 opposite from end 182. Such embodiments wouldnot include respective surfaces 28 e and 181.

Another aspect of the present disclosure may include providing varioustypes of packaging and/or kits for intraosseous devices in accord to theteachings of the present disclosure. Such kits may also be referred toas “containers” or “canisters”. See for example FIGS. 6A, 6B and 6C.Various molding techniques may be used to form such kits.

For embodiments such as shown in FIG. 6A kit or packaging 120 a mayinclude first recess 121 a and second recess 122 a. The generalconfiguration and dimensions of first recess 121 a may be selected toaccommodate placing intraosseous device 160 therein. The generalconfiguration and dimensions of second recess 122 a may be selected tobe compatible with placing surgical scalpel 124 therein. Indentions orfinger cutouts 126 and 128 may also be formed in kit 120 a proximaterecess 121 a and recess 122 a to accommodate removing intraosseousdevice 160 and/or scalpel 124 therefrom. Removable cover 130 a may beplaced over kit 120 a to retain intraosseous device 160 and scalpel 124in associated recesses 121 a and 122 a. Kit 120 a and/or removable cover130 a may be formed from various types of disposal materials including awide range of thermoplastic and polymeric materials.

For embodiments such as shown in FIG. 6B kit or packaging 120 b mayinclude first recess 121 b and second recess 122 b. First recess 121 bmay also be referred to as first container 121 b. Second recess 122 bmay also be referred to as second container 122 b. The generalconfiguration and dimensions of recess 121 b may be selected toaccommodate placing intraosseous device 160 therein. The generalconfiguration and dimensions of second recess 122 b may be selected tobe compatible with placing scalpel 124 therein. Removable cover 130 bmay be placed over kit 120 b to retain intraosseous device 160 andscalpel 124 in associated recesses or containers 121 b and 122 b. Kit120 b and/or removable cover 130 b may be formed from various types ofdisposal materials including a wide range of thermoplastic and polymericmaterials.

For embodiments such as shown in FIG. 6C kit or packaging 120 c mayinclude first recess 121 c and second recess 122 c. First recess 121 cmay also be referred to as container 121 c. Second recess 122 c may alsobe referred to as container 122 c. The general configuration anddimensions of recess 121 c may be selected to accommodate placingintraosseous device 160 therein. The general configuration anddimensions of second recess 122 b may be selected to be compatible withplacing at least portions of scalpel 124 therein. Removable cover or lid130 c may be placed over recess 121 c to retain intraosseous device 160therein. Kit 120 c and/or removable cover or lid 130 c may be formedfrom various types of disposal materials including a wide range ofthermoplastic and polymeric materials.

For some applications containers 121 c and 122 c may be formed asseparate components (not expressly shown). Alternatively, dual cylinders(not expressly shown) similar to container 121 c with respective lids130 c may be used to hold an IO device in one container and a scalpel inthe other container. Adhesive tape, shrink wrap or other suitablewrapping materials (not expressly shown) may be used to attach suchseparate containers with each other. Labels (not expressly shown) mayalso be placed on such kits to indicate IO devices appropriate forsternal access, adult access in a tibia or humerus, or pediatricprocedures.

Another aspect of the present disclosure may include providing acombined guide and/or depth control mechanism operable to install anintraosseous device at a selected insertion site in accordance withteachings of the present disclosure. For example, a combined guide anddepth control mechanism such as shown in FIGS. 7, 8B and 8C may besatisfactorily used to insert an intraosseous device into bone marrowadjacent to a selected insertion site. Combined guide and depth controlmechanism 60 may include generally elongated, hollow portion 62 whichmay be inserted into an incision formed in soft tissue covering aninsertion site. See FIGS. 8A and 8B.

Elongated, hollow portion 62 may sometimes be referred to as a collar ordepth limiter. For some applications elongated, hollow portion 62 mayinclude first end 61 with enlarged portion 70 extending therefrom.Enlarged portion 70 may be operable to limit movement of an intraosseousdevice through elongated, hollow portion 62. Second end 66 of elongated,hollow portion 62 may be sized to engage an anterior cortex at aselected insertion site.

For some embodiments enlarged portion 70 of combined guide and depthcontrol mechanism 60 may be generally described as a circular diskhaving first surface 71 and second surface 72. Enlarged portions withother configurations may be formed proximate first end 61 of elongated,hollow portion 62. Elongated, hollow portion 62 may extend from secondsurface 72 opposite from first surface 71. Elongated, hollow portion 62may include longitudinal bore or longitudinal passageway 74 extendingtherethrough.

Opening 68 may be formed in enlarged portion 70 adjacent to and alignedwith longitudinal passageway 74. Opening 68 and longitudinal passageway74 may be sized to received portions of an associated intraosseousdevice. See FIG. 8C. For some embodiments opening 68 may have agenerally tapered or funnel shaped configuration to assist in guidingone end of a intraosseous device therethrough.

For some embodiments such as shown in FIGS. 8A, 8B and 8C, a scalpel maybe used to form incision 84 in skin 80 and muscle or other soft tissue82 adjacent to insertion site 100 covering manubrium 92. Elongated,hollow portion 62 of combined guide and depth control mechanism 60 maythen be inserted into incision 84 until second end 66 contacts anteriorcortex 106 at insertion site 100. Incision 84 may be similar to anincision used to access a sternum.

Enlarged portion 70 of combined guide and depth control mechanism 60 mayinclude notch 64 disposed in an exterior portion thereof. Theconfiguration and dimensions of notch 64 may be generally compatiblewith notch 104 in manubrium 92. Prior to forming incision 84 atinsertion site 100, portions of an operator's finger (not expresslyshown) may be placed in both notch 64 and notch 104 to align combinedguide and depth control mechanism 60 with a desired insertion site. Ascalpel may then be used to form an incision at the indicated locationfor inserting collar 62.

After installing portions of combined guide and depth control mechanism60 within incision 84, various intraosseous devices may be insertedthrough longitudinal passageway 74. For some embodiments such as shownin FIG. 8C, portions of intraosseous device 160 d may be insertedthrough longitudinal passageway 74. Intraosseous device 160 d and ascalpel satisfactory for forming incision 84 may be obtained from a kitor packaging such as in FIG. 6A, 6B or 6C. Intraosseous device 160 d maybe similar to previously described intraosseous device 160. However,intraosseous device 160 d does not include collar or depth controllimiter 170. Collar 62 may sometimes be referred to as a “removabledepth limiter”.

Portions of outer penetrator 210 and associated inner penetrator 220 maybe inserted through opening 68 and longitudinal passageway 74. Manualdrivers 20, 20 d or an other suitable driver may be engaged withconnector receptacle 186 to insert portions of intraosseous device 160 dinto adjacent bone marrow 108. Insertion of intraosseous device 160 dmay continue until second end or flange 202 of hub 200 contacts firstsurface 71 of combined guide and depth control mechanism 60. For someapplications the extreme end of penetrators 210 and/or 220 may extendapproximately eight (8 mm) millimeters from end 66 of elongated, hollowportion 62 when second end 202 of IO device 160 d is resting on firstsurface 71 of enlarged portion 70.

Although the present disclosure and its advantages have been describedin detail, it should be understood that various changes, substitutionsand alternations can be made herein without departing from the spiritand scope of the disclosure as defined by the following claims.

What is claimed is:
 1. An apparatus for controlling the depth ofpenetration of an intraosseous device into a sternal bone and associatedbone marrow comprising: an outer penetrator having a first end and asecond end; the second end of the outer penetrator operable to penetratethe sternal bone and associated bone marrow; a hub having a first endand a second end; a flange disposed at the second end of the hub, theflange extending radially outward from the hub and configured to besupported by a skin surface of a patient to stabilize the intraosseousdevice; the first end of the outer penetrator disposed in the hub; thesecond end of the outer penetrator extending from the flange; a collarhaving an elongated and hollow configuration compatible with engagingthe outside diameter of the outer penetrator; the collar extending fromthe flange and disposed around a portion of the outer penetrator; thecollar having a first end disposed toward the hub and a second endextending at a selected distance from the flange; and where the distancebetween the second end of the collar and the second end of the outerpenetrator is non-adjustably fixed to control the depth of penetrationof the intraosseous device into the sternal bone and associated bonemarrow.
 2. The apparatus of claim 1, further comprising the distancebetween the second end of the hub and the second end of the collarlimiting the depth of penetration of the outer penetrator into thesternal bone and associated bone marrow.
 3. The apparatus of claim 1,wherein the first end of the collar is installed over an exteriorportion of the outer penetrator.
 4. The apparatus of claim 3, whereinthe first end of the collar is disposed within adjacent portions of thehub.
 5. The apparatus of claim 1, wherein the collar and respectiveexterior portions of the outer penetrator are operable to rotaterelative to each other.
 6. The apparatus of claim 1, wherein the outerpenetrator further comprises: a longitudinal passageway operable toslidably receive an inner penetrator; the inner penetrator having afirst end and a second end; the first end of the inner penetratoroperable to penetrate the sternal bone and associated bone marrow; theinner penetrator slidably disposed in the outer penetrator with thefirst end of the inner penetrator extending from the first end of theouter penetrator; and the distance between the second end of the collarand the first end of the inner penetrator determining the depth ofpenetration of the intraosseous device.
 7. The apparatus of claim 1,further comprising the collar from material selected from the groupconsisting of stainless steel, titanium or a material used to form theouter penetrator.
 8. The apparatus of claim 1, wherein the distancebetween the second end of the collar and the second end of the outerpenetrator comprises approximately eight (8) millimeters.
 9. Theapparatus of claim 1, wherein the depth of penetration of theintraosseous device comprises approximately eight (8) millimeters. 10.The apparatus of claim 1, wherein the spacing between the second end ofthe hub and the second end of the collar comprises approximatelyseventeen (17) millimeters.
 11. The apparatus of claim 1, wherein thelength of the outer penetrator is from five (5) millimeter to thirty(30) millimeter.
 12. An apparatus for controlling the depth ofpenetration of an intraosseous device into a sternal bone and associatedbone marrow comprising: an outer penetrator having a first end and asecond end; the second end of the outer penetrator operable to penetratethe sternal bone and associated bone marrow; a hub having a first endand a second end; a flange disposed at the second end of the hub, theflange extending radially outward from the hub and configured to besupported by a skin surface of a patient to stabilize the intraosseousdevice; the first end of the outer penetrator disposed in the hub; thesecond end of the outer penetrator extending from the flange; a collarhaving an elongated and hollow configuration compatible with engagingthe outside diameter of the outer penetrator; the collar extending fromthe flange and disposed around a portion of the outer penetrator; thecollar having a first end disposed toward the hub and a second endextending at a selected distance from the flange; and the distancebetween the second end of the collar and the second end of the outerpenetrator controlling the depth of penetration of the intraosseousdevice into the sternal bone and associated bone marrow; and wherein thespacing between the second end of the hub and the second end of thecollar is approximately the average thickness of skin, muscle and othersoft tissue covering the sternal bone.
 13. The apparatus of claim 1,wherein the spacing between the second end of the hub and the second endof the collar is variable.
 14. An apparatus for controlling the depth ofpenetration of an intraosseous device into a sternal bone and associatedbone marrow comprising: an outer penetrator having a first end and asecond end; the second end of the outer penetrator operable to penetratethe sternal bone and associated bone marrow; a hub having a first endand a second end; a flange disposed at the second end of the hub, theflange extending radially outward from the hub and configured to besupported by a skin surface of a patient to stabilize the intraosseousdevice; the first end of the outer penetrator disposed in the hub; thesecond end of the outer penetrator extending from the flange; a collarhaving an elongated and hollow configuration compatible with engagingthe outside diameter of the outer penetrator; the collar extending fromthe flange and disposed around a portion of the outer penetrator; thecollar having a first end disposed toward the hub and a second endextending at a selected distance from the flange; and the distancebetween the second end of the collar and the second end of the outerpenetrator controlling the depth of penetration of the intraosseousdevice into the sternal bone and associated bone marrow; wherein thespacing between the second end of the hub and the second end of thecollar is variable; and wherein the hub further comprises: a firstsegment having a first thread and a second segment having a secondthread; the first segment and the second segment operable to beingrotated with respect to each other; and the first thread and the secondthread having matching thread profiles operable to engage with oneanother upon rotation of the first segment with respect to the secondsegment whereby rotation of the first segment with respect to the secondsegment varies the spacing between the second end of the hub and thesecond end of the collar.
 15. The apparatus of claim 1, wherein thesecond end of the collar comprises an effective surface area largeenough to support up to fifty pounds of force without the second end ofthe collar penetrating bone surrounding an intraosseous space in asternum.
 16. An apparatus for controlling the depth of penetration of anintraosseous device into a sternal bone and associated bone marrowcomprising: an outer penetrator having a first end and a second end; thesecond end of the outer penetrator operable to penetrate the sternalbone and associated bone marrow; a hub having a first end and a secondend; a flange disposed at the second end of the hub, the flangeextending radially outward from the hub and configured to be supportedby a skin surface of a patient to stabilize the intraosseous device; thefirst end of the outer penetrator disposed in the hub; the second end ofthe outer penetrator extending from the flange; a collar having anelongated and hollow configuration compatible with engaging the outsidediameter of the outer penetrator; the collar extending from the flangeand disposed around a portion of the outer penetrator; the collar havinga first end disposed toward the hub and a second end extending at aselected distance from the flange; and the distance between the secondend of the collar and the second end of the outer penetrator controllingthe depth of penetration of the intraosseous device into the sternalbone and associated bone marrow; and further comprising at least oneblade disposed in at least one slot adjacent to the second end of thecollar.
 17. The apparatus of claim 1, wherein the collar comprises aremovable collar.